Protocol Overview

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Cancer Screenings #070901

Protocol Release Date

December 30, 2009

Protocol Name From Source

The Expert Review Panel has not reviewed this measure yet.

Description of Protocol

These self-administered questions ask about different cancer screening tests a respondent may have had in the past 3 years. The protocol includes the following screenings: mammogram, pap smear, pelvic examination, Prostate Specific Antigen (PSA) test, colonoscopy, ultrasound of the ovaries, barium enema, chest x-ray, sigmoidoscopy, and digital rectal examination.

Specific Instructions

All respondents are asked questions 1–3. Only female respondents are asked questions 4–8, and only male respondents are asked questions 9 and 10.

While not currently performed as part of routine cancer screening, the Working Group recommends including questions about two additional cancer screening procedures: Helical computed tomography (CT) scan and whole body scan.

Protocol

Questions for both Males and Females:

1. During the past three years, have you had a chest x-ray?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

2. During the past three years, have you had a test for blood in the stool?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

3. During the past three years, have you had a colonoscopy, sigmoidoscopy, or barium enema to examine the colon and rectum?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

Questions for Females Only:

4. During the past three years, have you had a mammogram?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

5. During the past three years, have you had a pap smear?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

6. During the past three years, have you had a pelvic examination?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

7. During the past three years, have you had an ultrasound or scan of your ovaries?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

8. During the past three years, have you had a blood test for ovarian cancer, for example, CA-125?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

Questions for Males Only:

9 During the past three years, have you had a digital rectal examination of the prostate?

[ ] No

[ ] Yes, once

[ ] Yes, more than once

[ ] Don’t know

10. During the past three years, have you had a blood test for prostate cancer, for example, PSA?